Provider Demographics
NPI:1750343554
Name:QIAN, XIAO YAN (MD)
Entity type:Individual
Prefix:
First Name:XIAO YAN
Middle Name:
Last Name:QIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40908
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-0908
Mailing Address - Country:US
Mailing Address - Phone:910-615-6448
Mailing Address - Fax:910-615-5070
Practice Address - Street 1:101 ROBESON ST
Practice Address - Street 2:STE 300
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5552
Practice Address - Country:US
Practice Address - Phone:910-615-1617
Practice Address - Fax:910-615-1618
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000941207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5912323Medicaid
NC5912323Medicaid